Permit 7 v
A li CITY OF TIGARD PLUMBING PERMIT
�J p, PERMIT #: PLM2000 -00057
DATE ISSUED:
;.�I� J DEVELOPMENT H BMEN9 Tigard, ) 639 v PARCEL: 2S102CB -03000
SITE ADDRESS: 12990 SW PACIFIC HWY
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Conversion of water heater to gas water heater.
FEES
Owner:
Type By Date Amount Receipt
RAHIER, MARTIN D PRMT DEB 2/25/00 $50.00 00- 321851
c/o TRAIN, ARTHUR T + JUDY M SPOT DEB 2/25/00 $4.00 00- 321851
4124 SE FRANKLIN
PORTLAND, OR 97202 Total $54.00
Phone 1:
Contractor:
OWNER
REQUIRED INSPECTIONS
1: Top -out Insp
Phone Final Inspection
Reg 1.
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notifi ' n ate . Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
40
Yo may obtain cop - of the • es or direct questions to OUNC by calling (503) 246 -1987.
Iss d By: kip. ,0
/ o_ Permittee Signature: i2-z, 4
Call (503) 63• 175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Ch ck#
13125 SW HALL BLVD. Commercial and Residential Rec'd B -
TIGARD, OR 97223 Date Rec'd ,'
(503) 639 -4171 Date to P.E.
Print or Type Date to D T
Incomplete or illegible applications will not be accepted Permit # Ge`0oe4 ° 05",
Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
•
Job /fifer %'
' ./Gr�/( Sink 11.50
Address S l et Address / Suite Lavatory 11.50
Id yso SW f C(, Tub or Tub /Shower Comb. 11.50
Bldg # City / e Zip '7 ' Shower Only 11.50
Name / Water Closet 11.50
S Urinal . 11.50
Owner Mailing Address Suite Dishwasher 11.50
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Name Washing Machine /Laundry Tray 11.50
Floor Drain/Floor Sink 2° 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone .
Water Heater conversion 0 like kind 11.50 5 0
Name Gas piping requires a separate mechanical permit. / /p
5 MFG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storn Sewer 32.00
Hose Bibs 11.50
Prior to permit City /State Zip Phone Roof Drains 11.50
issuance, a copy
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database
Name
Architect 5), y/ 99 Sewer- 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
C ity /State Zip Phone Water Service - 1st 100' 38.00
Engineer Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Tdtaf Is > 9
given is correct, that I am the owner or authorized agent of the owner, and *S ,
that plans submitted are in compliance with Oregon State Laws. Q
Sign re of er /Age t <- Date
� r „ 2s ;Zc'rj Bo 8% SURCHARGE g . '
Con t Pers n Name i Phone
tgd^ ® �6e "PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only it fixture qty. total Is > 9
2 BATH HOUSE $250.00 TOTAL A --�.i ei ��
. 3 BATH HOUSE $285.00 i '
(This fee Includes all plumbing fixtures In the dwelling and the first *Minimum
permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which Is $25 + 8% surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
I:ldstsVorrnstplumapp.doc 11/18199
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:1dstsVorms1plumapp.doc 11/18/99
3/6/00 Activities for Case #: PLM20O0 -00057
8:52:49 AM
Assigned Hold Updated
Activity Description Date I Date 2 Date 3 To Done By Disp. Level By Updated - Notes
PLMA003 Application received 2/25/00 DEB DONE No Hold DEB 2/25/00
PLMA005 Create Permit 2/25/00 DEB DONE No Hold DEB 2/25/00
PLMA725 Top -out Insp 2/25/00 2/25/00 • No Hold DEB 2/25/00
PLMA799 Final Inspection 2/25/00 - 2/25/00 2/28/00 TLP PASS No Hold AKJ 2/29/00
PLMA060 (F) Issue permit 2/25/00 DEB DONE No Hold DEB 2/25/00
PLMA800 Case Finaled 2/29/00 AKJ DONE No Hold AKJ 2/29/00 •
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Page 1 of 1
.. CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
c ^ / BUP
Date Requested 2 cYO AM PM BLD
Location o cigo �Cl �' ,[) Suite MEC 2000 — X)S
Contact Person Ph 2e - s 7
Contractor Ph SWR
BUILDING Tenant/Owner /1(,(„r�� ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam .
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall /
Fire Sprinkler g ?,j //111 'Q D/ C/ 1
Fire Alarm __ /_ - • 4r- . - A , y � — 5- -� � •
Susp'd Ceiling /�'/ = t v
Roof
Misc:
Final
PASS PART FAIL
,ELUMBIN 6 3 0 00 «77
Post &Beam f
Under Slab (A.)
Top Out
Water Service
Sanitary Sewer
Rain Drains
4 111La
• "1■ PART FAIL
Post & Beam
Rough In
as
Smoke Dampers
Fin.
fi'(:g/ PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA "
Otheoach /Sidewalk Date � U o Inspector
�' rl Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.